Chronic Pain can be a killer

Last year, a society task force report said, "studies ... show that chronic pain doubles the risk of death by suicide and that uncontrolled pain compromises immune function, promotes tumour growth and can slow healing with an associated increase in morbidity following surgery."

In its list of recommendations, made public under the title Wait Times for Access to Pain Treatment in Canada - A Sore Point for Sufferers, the task force suggested that six months should be the maximum wait time to protect the quality of life and psychological well-being of pain sufferers.

Dr. Philip Peng is an anesthesiologist and director of research at the Wasser Pain Management Centre. In his recently completed survey on access to multidisciplinary pain treatment in Canada, he estimates "there are only 120 such facilities available - equivalent to one in 258,000 population."

His survey revealed a shocking truth: "The wait time was more than one year in approximately one-third of the public multidisciplinary pain treatment facilities and could be as long as five years."

The median wait time at public facilities was 12 times longer than at private clinics, he says. While people relying on public facilities will wait about six months, you can get an appointment at a private clinic in about two weeks.

Desperate for relief, Canadians in pain who cannot get help are treating themselves.
Peng's research tells him that people in pain want fast relief. "At least 80 per cent of people who finally get into an appropriate multidisciplinary pain management centre will have tried non-prescription, anti-inflammatory drugs like Advil, herbal medicines and marijuana," he says.
The dearth of treatment facilities is made worse by the fact that too many clinicians - nurses, doctors and other health-care professionals - are not receiving adequate training in pain management.

According to University of Western Ontario pain specialist Dr. Dwight Moulin, too many doctors are woefully untrained in diagnosis and treatment of pain. As well, these doctors are often reluctant to prescribe powerful opioids because they worry about addiction and impaired breathing. But research has indicated that addiction rarely becomes a problem for patients who use their medications as prescribed.

The anxiety has been dubbed "opiophobia."
"For doctors, the use of strong painkillers is very time-consuming. You have to spend considerably more time with the patient," he says. Though he suggests medical teaching institutions are finally starting to appreciate the importance of training new physicians in pain management, he laments, "it will take years to filter down to people in practice."
Dr. Judy Watt-Watson, at the University of Toronto's faculty of nursing, has participated in a survey of the curricula at medical teaching facilities across Canada for the Canadian Pain Society. The study, which also reviewed veterinary teaching colleges, revealed that easing pain in pets is a primary concern, while institutions that train clinicians to treat people virtually ignore the subject.

Pain specialists wonder if all this untreated and undertreated pain is encouraging sufferers to go beyond herbal remedies, anti-inflammatories and smoking pot.

More worrisome, however, is the looming possibility that suffering patients will turn to more potent painkillers in their search for comfort.

While there is a reported increase in the number of people turning to painkillers to get high, most prescription painkiller abuse develops rather innocently.

After an injury or operation, for example, painkillers are prescribed. If the pain persists, sufferers may take matters into their own hands, by elevating doses and mixing painkillers with antidepressants or alcohol to increase the effect.

In the U.S., Science Daily reports, "Once hooked, patients may doctor shop to get multiple prescriptions to painkillers, forge prescriptions, order painkillers from websites that don't require prescriptions or take a road trip to Mexico to supply their habits."

A recent study reveals that in the U.S., the amount of five major painkillers sold at retail (over the counter or by prescription) rose 90 per cent between 1997 and 2005. That includes codeine, morphine, oxycodone, hydrocodone and meperidine (also known as Demerol).
In Canada, the market is growing, as well. The estimated number of prescriptions filled for analgesics rose from just over 16 million in 2002 to nearly 20 million between September 2006 and August 2007.

The U.N.-affiliated International Narcotics Control Board stated earlier this year, "Abuse of prescription drugs is about to exceed the use of illicit street narcotics worldwide, and the shift has spawned a lethal new trade - counterfeit painkillers, sedatives and other medicines, potent enough to kill."

It's a prescription for disaster, Lynch worries: greater access to and availability of potent analgesics and a health-care system that's not prepared to handle the pain.